According to new guidelines released by the American Heart Association, American College of Cardiology and The Obesity Society in November 2013, doctors should consider obesity a disease and more actively treat obese patients for weight loss. The guidelines reflect the latest information that scientists have about weight loss to prevent heart disease and stroke, the nation’s No. 1 and No. 5 killers.
“The subsequent health problems of obesity and the risk factors in a person’s family history passed down through the generations have become increasingly more of a burden. That’s the siren sound we can no longer ignore,” said Gordon Tomaselli, M.D., past president of the American Heart Association and co-chair of the subcommittee that guided the completion of the guidelines. Tomaselli is chief of cardiology at Johns Hopkins University School of Medicine in Baltimore.
Included in the new guideline is a first-of-its-kind roadmap to help patients lose weight and keep it off.
- Healthcare providers must find out who would benefit from weight loss by calculating at least once a year each of their patient’s body mass index (BMI), which is an indicator of obesity based on height and weight. Patients with a BMI of 30 or higher are considered obese and need treatment. In the U.S., nearly 78 million adults are obese. BMI in children is measured using a children's BMI calculator from the CDC.
- Patients would then participate in a medically supervised weight loss program two or three times a month for at least six months. “Telling patients they need to lose weight is not enough. We want healthcare providers to own the problem. Just like they own the problem of glycemic control in a patient with diabetes, they need to own the problem of weight management,” said Donna Ryan, M.D., co-chair of the committee that wrote the guidelines and professor emeritus at Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge.
- Physicians also should consider weight-loss surgery for severely obese patients who have one or more obesity-related health problem, such as diabetes, sleep apnea or high blood pressure. In the past, doctors waited until patients were struggling with two such issues. The guidelines do not endorse any one weight loss surgery. Rather, the choice of procedure should be based on the person’s age, severity of obesity, the risk of complications and other factors. In the U.S., about 200,000 adults have bariatric surgery each year. Learn more about extreme obesity.
The best strategy to lose weight and keep it off requires a three-pronged approach:
- Eat fewer calories than your body needs,
- Exercise more and
- Change unhealthy behaviors.
More people benefit from weight loss than previously thought.
The new guideline also recommends weight loss for some overweight people. Someone would qualify with a BMI of 25 to 29.9, and one risk factor, such as elevated blood pressure or high triglycerides (blood fats). That’s a change from the 1998 federal guidelines that said overweight people needed to have at least two risk factors to benefit from weight loss.
Behavioral strategies may include monitoring weight, setting goals, tracking food and calorie intake and creating an environment at home and work that discourages overeating. Counseling also helps people shore up their ability to deal with temptations and other challenges to their weight-loss plan.
Patients are more likely to follow a weight loss routine when guided by a registered dietitian, behavioral psychologist or other trained professional in a healthcare setting, according to the guidelines. Telephone- and web-based weight loss programs also work, though not as well.
‘There is no magic diet for weight loss.’
The new guidelines finally put to rest the idea that there is an ideal weight loss diet for everyone, Ryan said, adding, “There is no magic diet for weight loss.”
In fact, she said, more than a dozen dietary patterns have proven effective in helping people lose weight as long as they involve eating fewer calories than the body needs to maintain weight. Some diets call for higher protein. Others are built on eating fewer carbohydrates or reduced fat.
Your doctor should use your food preferences and health to select the most appropriate diet. For example, someone with high cholesterol might benefit most from a low-fat diet that reduces both weight and cholesterol.
People also don’t need to reach a normal weight to reap the health benefits of weight loss. Shedding even a modest number of pounds can have significant health benefits, said Frank Hu, M.D., Ph.D., an American Heart Association volunteer who helped write the guidelines.
“Sustained weight loss of just five percent can significantly lower blood pressure, blood glucose and improve blood lipids,” said Hu, a professor of nutrition and epidemiology at Harvard School of Public Health in Boston.
For a 180-pound woman, that’s a weight loss of just nine pounds. Even as little as 3 percent weight loss can lower the risk for Type 2 diabetes, the guidelines say.
For people trying to keep the weight off, exercise is more essential.The guidelines recommend 200 to 300 minutes of physical activity a week to prevent extra pounds from creeping back. People should also participate in a weight loss maintenance program for at least one year. “You really need a full year to engrain those healthy behaviors around food and exercise,” Ryan said.